Healthcare Provider Details

I. General information

NPI: 1336717651
Provider Name (Legal Business Name): KRISTINA A. BROOKS M.ED., LPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7984 NEW LA GRANGE RD
LOUISVILLE KY
40222-4718
US

IV. Provider business mailing address

7984 NEW LA GRANGE RD
LOUISVILLE KY
40222-4718
US

V. Phone/Fax

Practice location:
  • Phone: 502-426-2777
  • Fax: 502-426-2776
Mailing address:
  • Phone: 502-426-2777
  • Fax: 502-426-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number271079
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: